An operative case of gastric cancer with ectopic bile duct drainage in the lesser curvature of the stomach.

BACKGROUND: Among the various anomalies of the biliary system, a double common bile duct with ectopic drainage in the stomach is rare. Furthermore, ectopic bile ducts are extremely rare in gastric cancers. CASE PRESENTATION: A 67-year-old man was admitted to our hospital with gastric cancer and ectopic left extrahepatic bile duct drainage in the stomach. Pre-operative testing revealed no communication between the intrahepatic bile ducts. Distal gastrectomy and bile duct jejunostomy were performed. The post-operative course was uneventful, and the patient did not exhibit recurrence for 39 mo. CONCLUSIONS: Although it is uncertain whether sustained bile exposure from an ectopic bile duct is related to gastric cancer, short-term follow-up might be necessary because of the possibility of gastric cancer.

[Successful gefitinib every other day administration in an advanced lung cancer patient with brain metastasis after gamma knife radiotherapy and chemotherapy].

A 69-year-old female, who had been admitted to another hospital with a complaint of headache and there detected brain tumor, was referred to our hospital for further examination and therapy. The patient was diagnosed as having advanced lung cancer with multiple brain metastasis. She was treated with five courses of a combination of chemotherapy consisting of carboplatin and paclitaxel following gamma knife radiotherapy. She showed a remarkable response, however, she experienced the side effects of general fatigue and numbness in her extremities, which were intolerable. Then, therapy with gefitinib alone was chosen as second-line chemotherapy. After one month, this therapy was discontinued due to grade 3 skin trouble and rash. When her condition improved, every other day oral administration of gefitinib was resumed. She has been treated on an outpatient basis because of no severe adverse reactions. The patient is alive with good performance status (PS) 0 more than one year after taking gefitinib. Furthermore, the primary and metastatic tumors are not enlarged. Gefitinib orally administered every other day could be a promising regimen as second-line chemotherapy for patients with lung cancer and brain metastasis.

[Adjuvant epirubicin and cyclophosphamide followed by weekly paclitaxel for Japanese women with node-positive breast cancer: a multi-institutional feasibility study].

We evaluated the feasibility of epirubicin plus cyclophosphamide(EC)followed by weekly paclitaxel (wPTX) as an adjuvant therapy for node-positive breast cancer in a variety of practice settings. Thirty-two patients received EC (twenty-two: 75, 600 mg/m(2), ten: 90, 600 mg/m(2))every 3 weeks for 4 cycles. Twenty-eight of them received wPTX for 4 cycles subsequently, which were 3 consecutive weekly administrations with a following week pause per cycle. Grade 3 or 4 hematologic toxicity included leukopenia(5 for E75C600, 6 for E90C600, 2 for wPTX), neutropenia(6 for E75C600, 8 for E90C600, 4 for wPTX), febrile neutropenia (1 for E90C600), anemia (1 for wPTX), and GOT/GPT elevation (1 for wPTX). Non-hematologic toxicity of more than grade 3 was not seen. There were seven treatment discontinuations, including four patients' refusal, two allergic reactions to paclitaxel, and one liver dysfunction. EC followed by wPTX can be safely performed with a little toxicity at doses of 75/90 mg/m(2), 600 mg/m(2) and 80 mg/m(2), respectively.

Role of femorofemoral crossover bypass grafting for unilateral iliac atherosclerotic disease: a comparative evaluation with anatomic bypass.

PURPOSE: To assess the role of femorofemoral or iliofemoral crossover bypass grafting, the early and late results of crossover bypasses were reviewed and compared with those of anatomic bypasses. METHODS: The clinical records of 164 patients with arteriosclerosis obliterans who underwent 99 crossover bypasses and 65 anatomic ones from 1982 to 2002 were retrospectively evaluated. The early and late results including operative mortality and morbidity, graft patency rate, limb salvage rate, and survival rate of the patients as well as backgrounds of the patients were compared between the two kinds of bypass procedures. In addition, perioperative factors including bypass procedures affecting graft patency were evaluated by a multivariate analysis. RESULTS: The percentage of high-risk patients was higher in the crossover bypass group than in the anatomic bypass group. The operative mortality and morbidity were similar between both bypass groups. The primary and secondary patency rates of crossover bypass grafts (93% and 97%, 83% and 92%, and 65% and 63% at 2, 5, and 10 years, respectively) were lower than those of anatomic ones (95% and 98%, 93% and 98%, and 90% and 98% at 2, 5, and 10 years, respectively). The late survival of the patients in the crossover bypass group was significantly lower than that in the anatomic bypass group. A multivariate analysis revealed the operative method, namely the crossover bypass, to be the only significant risk factor of late graft failure. CONCLUSION: A crossover bypass was thus determined to be an acceptable procedure only in high-risk patients with a limited life expectancy.